Provider Demographics
NPI:1649260696
Name:LIGHTFOOT, DAVID V (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:V
Last Name:LIGHTFOOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4421
Mailing Address - Country:US
Mailing Address - Phone:707-575-3800
Mailing Address - Fax:707-528-4967
Practice Address - Street 1:720 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4421
Practice Address - Country:US
Practice Address - Phone:707-575-3800
Practice Address - Fax:707-528-4967
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57122207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB003OtherCHAMPUS
CA00G571220Medicaid
CA180009845OtherRAILROAD MEDICARE
CAB003OtherCHAMPUS
CAA53238Medicare UPIN